What question did this study set out to answer?

To assess whether integrating geriatric assessment into tumor board plans affects treatment decisions and costs for older adults with thoracic oncology.

May 30, 2026

Cost impact of GA-informed re-evaluation of multidisciplinary tumor board plans in thoracic oncology.

Puntos clave

To assess whether integrating geriatric assessment into tumor board plans affects treatment decisions and costs for older adults with thoracic oncology.
Cost analysis of treatment decisions in 100 patients aged ≥70 years in a thoracic oncogeriatrics clinic.
Comparison of initial tumor board strategies with treatment post geriatric assessment re-evaluation.
Direct costs included drug acquisition, administration, planned cycles, and other non-pharmacologic costs over a 3-month period.
GA-informed re-evaluation modified initial plans in 59% of patients with significant changes in therapy.
Total direct cost reduction was 620,659 EUR, remaining 603,289 EUR after personnel costs.
Changes primarily driven by frailty-related vulnerabilities, with 72.7% of omissions linked to geriatric findings.

Resumen

e23156 Background: Standard thoracic oncology regimens in older adults may not reflect multidomain geriatric vulnerabilities or goals of care, increasing the risk of over- and undertreatment. We evaluated whether integrating comprehensive geriatric assessment (GA) and shared decision-making into a simultaneous geriatrics-oncology clinic within the tumor board (MTB) pathway modified initial MTB plans and had direct cost implications versus usual care. Methods: Cost analysis of prospectively documented treatment decisions in the first 100 consecutive patients aged ≥70 years evaluated in a thoracic oncogeriatrics clinic (Jan/24–Mar/25). The initial MTB strategy was compared with treatment after GA-informed re-evaluation; GA findings and patient goals were fed back to the MTB to revise recommendations. Hospital-perspective direct costs included drug acquisition (EUR/vial), administration, planned cycles, and non-pharmacologic planned costs linked to the strategy (diagnostic procedures, radiotherapy, surgery), using the period from treatment start to first clinical re-evaluation (3 months). Unit prices were obtained from hospital management sources; geriatrician personnel costs were included. Results: GA-informed re-evaluation modified the initial MTB plan in 59 of 100 patients (mean age 78.5 ± 5.0). Changes included omission of planned systemic therapy (22/59), dose reduction/intensity de-escalation (21/59), regimen or schedule adaptation/early reassessment (11/59), and local/diagnostic strategy change (14/59); categories were not mutually exclusive. Among omissions (n = 22), 16 (72.7%) were driven by frailty-related vulnerabilities identified through GA and 6 (27.3%) reflected watchful waiting aligned with patient preferences. Total direct cost reduction was 620,659 EUR and remained 603,289 EUR after accounting for geriatrician personnel costs. Conclusions: Early implementation of a simultaneous geriatrics-oncology clinic within the MTB pathway frequently altered initial plans, primarily reflecting objective geriatric vulnerabilities. These changes were associated with substantial reductions in direct healthcare costs as a secondary outcome, supporting age-integrated models that improve treatment appropriateness and value. Changes by frailty status. Frailty status Patients with decision change, n/N (%) Omission of systemic therapy, n/N (%) Dose reduction / intensity de-escalation, n/N (%) Regimen or schedule adaptation / early reassessment, n/N (%) Local or diagnostic strategy change, n/N (%) Fit 3/22 (13.6%) 0/3 (0.0%) 3/3 (100.0%) 0/3 (0.0%) 0/3 (0.0%) Pre-frail 27/41 (65.9%) 7/27 (25.9%) 12/27 (44.4%) 6/27 (22.2%) 3/27 (11.1%) Frail 22/30 (73.3%) 8/22 (36.4%) 6/22 (27.3%) 5/22 (22.7%) 11/22 (50.0%) Poor prognosis 7/7 (100.0%) 7/7 (100.0%) 0/7 (0.0%) 0/7 (0.0%) 0/7 (0.0%) Total 59/100 (59.0%) 22/59 (37.3%) 21/59 (35.6%) 11/59 (18.6%) 14/59 (23.7%)

Me gusta

Guardar